Imported: Gi_Test 2: Gotfried_Gi Mass

Front 1

R.M. a 68 year old female presents with a chief complaint of Lower Left Quadrant Abdominal Pain

Her pain is described as constant in duration, increasing in severity and aggravated by coughing and motion. She states that her pain began about 3 days ago as colicky in nature, accompanied by nausea, but no emesis, and was localized to her lower abdomen. She has no prior history of similar episodes. Today she experienced chills, and admits to anorexia.

Her past medical history is positive for Type II Diabetes Mellitus, and Hypertension both well controlled, and for Hiatal Hernia. She had an Appendectomy at age 12, a Cholecystectomy at age 40, and no other surgeries, and was hospitalized for the vaginal delivery of four children ages 40, 38, 30 and 28. (para IV-0-0-IV).
Her Systems review was generally unremarkable. She admitted to recent constipation, but denied melena, or rectal bleeding. She denied recent weight loss, dysuria or frequency.

Her abdomen appears distended with tenderness to palpation in her lower left quadrant, with guarding and rebound tenderness. There is a well healed lower right quadrant paramedian scar, and an upper right quadrant paramedian scar.

Auscultation of her abdomen reveals bowel sounds to be reduced in frequency and increased in pitch.
There are is a palpable LLQ mass, (tender), there are no hernias.
Bimanual vaginal exam reveals tenderness in the LLQ, her adnexa are not palpable, her uterus is atrophic. Digital rectal exam is normal.

Back 1

diverticulitis

Front 2

what group is most likely to get colon cancer?

*in white

Back 2

black men

(followed by white men, then black woman)

Note; onset is earlier, mortality is higher

Front 3

when should you start screening for CRC for black men?

*in white

Back 3

45 years old

normally you would look around 50

Front 4

what type of diet is more likely to cause CRC?

*white

Back 4

higher amounts of animal fats and processed meats, lower amounts of fiber

Front 5

Which of the following have an impact on risk and could potentially alter the physician's recommendations for CRC screening in our patient, Mr. G?

Race
Gender
BMI
Age
All of the above

Back 5

All of the above

Front 6

the incidence of CRC increases with...

Back 6

age

Front 7

Familial adenomatous polyposis (FAP) if untreated...

Back 7

colorectal cancer develops in nearly 100% of these patients by age 40 years.

remember APC gene! (to Ras to p54)

Front 8

REVIEW: Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited condition in which patients have an 80% chance of developing colorectal cancer at an age < 50 yrs, with fewer polyps than FAP

Back 8

(MSH2, MLH1 mismatch repair gene problem)

Front 9

ok so once more, this was in red, The primary risk factor is ___ for CRC?

Back 9

AGE

Front 10

Which of the following is a correct follow-up action for a positive FOBT (fecal occult blood test)?
If positive test result was from a guaiac test, repeat testing with an FIT
Colonoscopy
Stool DNA test
Double-contrast barium enema
Flexible sigmoidoscopy

*white

Back 10

Colonoscopy

Front 11

GOLD standard for CRC screening?

**TEST

Back 11

colonoscopy

Front 12

cure for about 50% of pts with CRC?

*in green

Back 12

surgery

Front 13

The prognosis of colon cancer is clearly related to ... (3)

*green

Back 13

the degree of penetration of the tumor through the bowel wall and

*the presence or absence of nodal involvement, and

*the presence or absence of distant metastases

Front 14

when do you stop giving scopes?

Back 14

Treatment decisions depend on factors such as physician and patient preferences and the stage of the disease rather than the age of the patient.

Front 15

occult bleeding is associated with what kind of colon cancer? why?

Back 15

right sided

(you would see the blood if it were left sided!)

Front 16

obstruction is associated with what kind of colon cancer?

Back 16

left sided

Front 17

Unexplained Iron Deficiency Anemia is associated with what kind of colon cancer? why?

*green

Back 17

right sided colon cancer

occult bleeding that the pt is not aware of occurring over a long period of time

Front 18

weight loss, jaundice, ascites are signs of what?

*RED

Back 18

metastasis of left sided CRC

Front 19

Primary site of metastisis for CRC?

**TEST

Back 19

liver

number 2 is lung

3 brain

Front 20

Endoscopic removal of adenomatous polyps decreases the risk of developing bowel cancer by >75%

*

Back 20

he had this on a slide 4 times!

Front 21

If detected early, colorectal cancer is curable by

Back 21

Surgery!

suck it!

Front 22

majority of Colon cancers occur where?

Back 22

Sigmoid

(cecum for black males)

Front 23

_______ is the most frequently injured organ in blunt abdominal trauma

***

Back 23

the spleen

Front 24

If you see any of these in a pt's history, what should you think?

- blunt, (MVA), or penetrating trauma (knife/gunshot) to the left thorax, left abdomen, left flank, particularly when associated with RIB FRACTURES.

Back 24

Slpenic Injury

Front 25

Splenic Injury is particularly associated with ________ fractures

Back 25

RIB

Front 26

What is Kehr's Sign? What does it indicate?

**

Back 26

- pain referred to the left shoulder with or without physical signs of hemodynamic instability, signs of hemoperitoneum (i.e. generalized and non-specific ULQ abdominal pain)

**Splenic Injury or Acute Pancreatitis**

Front 27

What is Cullen's Sign?

Back 27

periumbilical ecchymosis

(Blood in abdomen, possibly from splenic rupture)

Front 28

What is Grey-turner's sign?

Back 28

eccymosis over the flanks

(Blood in abdomen, possibly from splenic rupture)

Front 29

What is the most accurate method available of diagnosing a splenic rupture?

**

Back 29

CT Scan

Front 30

What 3 CT findings predict the need for surgical intervention in a patient with a suspected splenic rupture?

Back 30

1. Devascularization or laceration involving more than 50% splenic viscera

2. Contrast blush >1cm

3. Large hemoperitoneum

Front 31

Non-operative management of splenic injury (NOMSI) is currently used in up to 70% of patients with blunt splenic injury.

What are some requirements?

(OBJ)

Back 31

**A stable patient (hemodynamic instability mandates surgery)**

- isolated splenic injury

- patient could be examined reliably

- systolic BP >90mm/Hg

- no peritoneal signs

- transfusion <4 units of blood.

Front 32

What are the immunologic consequences of total splenectomy?

Back 32

impaired phagocytic activity to clear various blood borne particles
**encapsulated organisms (**strep pneumo, h. influenza b, Neisseria meningitidis, E. coli).

- Decreased levels of immunoglobulin to specific antigens

- decreased T-cell function, opsonization, properidin levels.

Front 33

What is "Post Splenectomy Sepsis"?

Back 33

patient develops severe sepsis, frequently pneumococcal pneumonia, death.

The risk is greatest in children <4 years and within 2 years of splenectomy.

Front 34

What is the most important pathogen regarding "Post Splenectomy Sepsis"? What can we do to stop it?

Back 34

STREP PNEUMONIAE

-Prophylactic penecillin for at least 5 yrs

- Pneumovax 23

Front 35

Diseases where splenectomy is indicated:

What is the most common hematologic indication for Splenectomy?

Back 35

Idiopathic Thrombocytopenia Purpura (ITP)

(inadequate response to steroids, relapse after remission, disease presents >1 year)

Front 36

What is the 3rd most common cause of death from cancer in the US?

Back 36

colon cancer

Front 37

What is the 3rd most frequent type of cancer in the US?

Back 37

colon cancer

Front 38

What is the primary risk factor for colon cancer?

Back 38

AGE

>90% of cases in pts over age of 50 (avg 63yo)

Front 39

Note: you may find a palpable abdominal mass when doing a physical for colon cancer

Back 39

it was green

Front 40

***EXAM****

Endoscopic removal of adenomatous polyps decrease the risk of developing bowel cancer by >75%!!!!!!!

****EXAM****

Back 40

***EXAM***

If detected early, colon cancer is curable by surgery!!

***EXAM****

Front 41

What do Dukes Stage D and TMN stage IV (different systems for grading Colon Cancer) coloncancer have in common?

Back 41

Both Show DISTANT METASTASIS

**Poor Prognosis**

Front 42

How does colon cancer spread?

Back 42

-Blood

-Lymph

-Organ to Organ

-Peritoneal Seeding

Front 43

Colon Cancer:

Chemotherapy is for _____ positive patients.

Back 43

Node positive patients

Front 44

Post-surgical surveillance after colon cancer resection?

Back 44

- Colonoscopy every 6 mo. for a year

-Yearly colonoscopy thereafter

-Yearly Liver Fxn Scan

-CT scan every 5 years

Front 45

What is the most common symptom of rectal cancer?

Back 45

bleeding

Front 46

Rectal Cancer Clinical Presentation and Sx?

Back 46

gastrointestinal bleeding

change in bowel habits

abdominal pain

intestinal obstruction

weight loss

change in appetite

weakness.

Front 47

The rectum measures about 12-15cm from the ________

Back 47

Anal Verge

Front 48

Surgery for Rectal Cancer:

Upper 1/3

Back 48

Upper 1/3 – resection and anastamosis

Front 49

Surgery for Rectal Cancer:

Middle 1/3

Back 49

-abdomino-perineal resection (Miles),permanent colostomy

-low anterior resection (may require temp. colostomy)

-local excision or fulguration,

- primary radiation therapy

Front 50

Surgery for Rectal Cancer:

Lower 1/3

Back 50

abdomino-perineal resection- permanent colostomy

local excision or fulguration,

primary radiation therapy

Front 51

Rectal cancer:

-Post-operative adjuvant radiation and chemotherapy should be offered to ALL patients with ____ or _____ positive disease

Back 51

Transmural or node positive disease

Front 52

Name the condition:

TRIAD of:
1) hypotension/shock

2) pulsatile abdominal mass

3) abdominal back pain

**always suggests rupture, 5.5 cm is the diameter for elective surgical treatment**

Back 52

AAA

Front 53

Risk Factors:

-smoking
-HTN
-Hyperlipidemia
-Family Hx
-Male Gender
-Age
-Triad of hypotension, pulsatile abd mass, abd back pain

Back 53

AAA

Front 54

Pathophysiology of AAA?

Back 54

Aortic medial layer fragmentation and degeneration of elastin

Front 55

What procedure is best for screening and initial diagnosis of AAA?

Back 55

Ultrasound

Front 56

What do you do with a pt has an aortic aneurysm greater than 5.5cm?

Back 56

Surgical repair!!

Front 57

These medical treatments are for:

-Beta blockers

-Doxycycline

-Aspirin/Statins

-Control HTN

-Stop smoking

Back 57

AAA